MP13-07 UNDERDIAGNOSIS OF LICHEN SCLEROSIS IN ISOLATED BULBAR URETHRAL STRICTURES

Abstract

INTRODUCTION AND OBJECTIVES: Lichen Sclerosus (LS) is a chronic inflammatory genital skin condition that can cause destructive urethral scarring in men. No prior studies have reported LS in isolated bulbar urethral stricture segments without the presence of progressive disease originating from the penile urethra and/or preputial skin. The aim of this study was to determine the incidence of LS in isolated bulbar urethral stricture segments. METHODS: We retrospectively reviewed 70 patients undergoing urethroplasty for isolated bulbar stricture disease between 20072013. Demographic information, etiology, comorbidities, prior procedures, surgical intervention, outcomes and pathology were reviewed. Stricture specimens at the time of urethroplasty were retrospectively reviewed by a single uropathologist, blinded to patient history and prior histopathologic diagnosis. Cases were evaluated using common histologic features in LS including hyperkeratosis or epithelial atrophy, vacuolar degeneration of basal cells, lichenoid lymphocytic infiltrate and presence of superepithelial sclerosis. RESULTS: The average age of patients was 46.5 (19-77) years and stricture length was 3.5 (1-7) cm. 10 patients (14.2%) had a smoking history, 43 (61.4%) had undergone prior intervention for stricture, of which 3 (4.3%) had prior urethroplasty and 5 (7.1%), prior hypospadias. 51 patients (73.0%) underwent excision and primary anastomosis, and 18 (25.7%) and 1 (1.4%) underwent dorsal or ventral onlay of buccal mucosal graft, respectively. 6 patients (8.6%) developed recurrent stricture requiring intervention over a median follow-up of 22 (IQR 14, 44) months, of which 3 had LS. Initial surgical pathology showed LS in 5 patients, or 7.1% (CI 1.0-13.3). On re-review of specimens using LS pathologic criteria, 31 patients, or 44.3% (32.4-56.2), showed pathology highly suggestive (13) or diagnostic (18) for LS (p<0.05). No significant difference existed between patient characteristics with and without LS on re-review. On univariate analysis, diabetes and pathologic diagnosis of LS are associated with recurrence after bulbar urethroplasty (p1⁄40.03). On multivariate analysis controlling for age, prior procedures and diabetes, no significant association was found. CONCLUSIONS: We report a significant incidence of LS in isolated bulbar strictures in men undergoing urethroplasty on re-review of surgical specimens. The incidence of LS may be higher than reported in isolated segments of the bulbar urethra without evidence of progressive disease.